Protected Health Information (PHI) is health information that can identify an individual and relates to their past, present, or future physical or mental health, the care they receive, or payment for that care. This information includes a broad range of data, such as medical records, lab results, billing statements, and demographic details like name and address. The communication of this data is subject to strict federal standards designed to ensure its privacy and security across all platforms and methods of transmission. These standards govern how healthcare providers, health plans, and other entities must handle and share PHI, regardless of the medium used. Understanding the pathways through which PHI moves and the safeguards required for each channel is important for protecting patient confidentiality.
Oral Communication and Incidental Disclosure
The most common way PHI is communicated is through spoken word, such as in-person conversations during patient consultations, phone calls between providers, or dictation for medical notes. While direct verbal exchange is necessary for treatment, it carries the risk of unintended disclosure. Personnel are required to implement “reasonable safeguards” that minimize the chance of unauthorized people overhearing sensitive information.
These safeguards involve practical steps, such as keeping voices lowered when discussing a patient’s condition in a semi-private area or moving sensitive conversations to a private office or exam room. Healthcare staff must also be mindful of their surroundings, avoiding the use of patient names in public spaces. Phone calls involving PHI should take place on a private line or in an area where the conversation cannot be easily intercepted.
Federal regulations recognize “incidental disclosure,” which refers to a secondary disclosure that cannot be reasonably prevented and occurs during an otherwise permitted activity. Calling a patient’s name in a waiting room or a visitor briefly glimpsing a patient chart are common examples. Such disclosures are not considered violations, provided that reasonable safeguards, such as using privacy screens on computer monitors or coded sign-in sheets, were in place to limit the risk.
Paper-Based and Physical Transmission
PHI is still communicated through physical paper documents, including traditional paper charts, prescription forms, mailed records, and fax transmissions. This physical form requires stringent controls to prevent loss, theft, or unauthorized viewing. The primary safeguards center on securing the documents both when they are at rest and when they are in transit.
Physical records must be kept in locked file cabinets or restricted-access rooms that limit entry to authorized personnel. When documents are transported, such as moving charts between departments or mailing records, they should be covered or placed in secure, non-transparent containers. Mailed records often require tracking logs to maintain a chain of custody.
Faxing Protocols
Faxing is permissible but must follow specific protocols. Before sending a document, staff must verify the recipient’s fax number to prevent misdirection, often using a verified contact list. A confidentiality cover sheet must be used, and the fax machine should be located in a secure area where only authorized personnel can access incoming PHI.
Secure Disposal
When paper records are no longer needed, they must be disposed of using methods that render the PHI unreadable, such as pulverizing or cross-cut shredding. Many entities obtain a Certificate of Destruction as proof of secure disposal.
Structured Electronic Health Record Systems
The primary method for communicating and storing PHI today is through dedicated Electronic Health Record (EHR) systems and integrated patient portals. These systems are governed by federal security standards, which mandate a multi-layered approach to protecting electronic PHI (ePHI). The security architecture is built directly into the software to facilitate compliant communication for core healthcare activities like treatment, payment, and healthcare operations.
Access Controls
A fundamental technical safeguard is mandatory user authentication, requiring unique user identifiers and strong passwords or multi-factor authentication (MFA). EHRs employ role-based access controls (RBAC) to enforce the “minimum necessary” principle. This means access permissions are automatically tailored to the specific ePHI required for a user’s job function, whether they are a nurse, billing specialist, or physician.
Security and Accountability
EHR systems are equipped with audit controls that log all user activity, creating a comprehensive audit trail. This record tracks every instance of data creation, modification, and access, which is essential for investigating potential security incidents. The data itself is protected by encryption, both when stored within the system (“at rest”) and when sent between authorized components (“in transit”).
External Electronic Communication and Telehealth
External electronic communication involves transmitting PHI outside of the internal, structured EHR environment, typically via email, text messaging, cloud storage, or video conferencing for telehealth services. This category carries a higher risk profile and requires advanced technical and contractual safeguards. The core requirement for any external electronic transmission of PHI is the use of encryption, which must secure the data both while it is moving across networks and while it is stored on external devices or servers.
Email and Text Messaging
For email and text messaging, end-to-end encryption is necessary to ensure that only the sender and the intended recipient can access the content. While a patient may consent to receiving unencrypted PHI, providers are still responsible for applying reasonable safeguards and informing the patient of the risks.
Business Associate Agreements (BAA)
The use of third-party vendors for cloud storage, messaging, or telehealth platforms requires a specific legal contract known as a Business Associate Agreement (BAA). The BAA legally obligates the third-party vendor, known as a Business Associate, to protect the PHI with the same security standards as the healthcare entity.
Telehealth Platforms
For telehealth, platforms must provide secure video conferencing with robust privacy features, access logging, and strong authentication methods like multi-factor authentication. These measures ensure that remote care and external data sharing maintain the confidentiality and integrity of patient information, even when it leaves the closed environment of the EHR.